Fighting ignorance since 1973.(It's taking longer than we thought.)

Is it true that Victorian doctors used to masturbate neurotic female patients to orgasm and used special new inventions (e.g., vibrators) to do so? If so, does this have any connection with Freud's theories on female sexuality?

Rob King, via e-mail

Illustration by Slug Signorino

Cecil replies:

Just a few tweaks: (1) the women were diagnosed as hysteric, not neurotic; (2) vibrators were used, but contrary to rumor that wasn’t their original purpose; and (3) Freud helped end, not start, the practice. But mainly you’ve got it: the medical profession long treated such patients by fiddling with their genitalia – a subject receiving its most thorough examination in Rachel Maines’s The Technology of Orgasm (1998).

The always nebulous concept of hysteria was known to the ancients; its original symptom was difficulty breathing, which as of 1900 BC was attributed by Egyptians to the uterus’s straying toward the lungs and throat. One early treatment (persisting into the Middle Ages) involved smearing foul substances near the nose and sweet ones near the crotch to goad and lure the errant organ back into place. Such beliefs influenced writings attributed to Hippocrates circa 400 BC. These portray a sex-starved or otherwise desiccated uterus wandering the body in search of moisture, occasionally disrupting breathing; one text recommends genital massage in response, though whether this was supposed to culminate in a happy ending isn’t certain. Hippocrates concluded marriage and sex were the best cures but also advocated sneezing.

Several centuries later, medical pioneer Galen also blamed the uterus for hysteria but denied its upward mobility. He believed female “sperm” (probably female ejaculate, as discussed here before, see The Straight Dope: What’s in female ejaculate?) was released during sex; its accumulation via abstinence could produce toxic vapors, resulting in hysterical symptoms, namely shortness of breath and convulsions. (This idea, incidentally, gave rise to the notion of “the vapors,” scourge of Victorian gentlewomen and southern belles, though by then doctors no longer believed actual vapors were causative.) For unmarried patients Galen prescribed “digital manipulation” by a midwife to the point of “twitching,” “pleasure,” and the release of “abundant sperm” – i.e., to orgasm. Over ensuing generations, influential pagan, Christian, and Muslim physicians continued to recommend such treatment, with midwives continuing to do the grunt work. Under Christianity the practice was controversial, but some doctors persisted, considering Catholic objections mere superstition.

By the mid-1800s symptoms of hysteria included inability to reach orgasm through vaginal intercourse and sexual fantasies accompanied by vaginal lubrication and an urge to masturbate. In short, normal female sexuality had been classified as pathological, and doctors stood ready to battle the epidemic. French physician Pierre Briquet popularized la titillation du clitoris (rather than du vagina or cervix) as treatment for hysterics. In the post-Briquet era massages were given to married patients as well, now by doctors or nurses rather than midwives.

If this all sounds wildly sketchy, consider alternative hysteria treatments, ancient and subsequent. Some operated on the first-do-no-harm model (cod liver oil, radishes), some on the let’s-get-you-high model (alcohol, cannabis, opium, cocaine). But others were less benign: dosing with arsenic, rubbing the genitals with dung, applying leeches to the cervix, injecting milk (likely unpasteurized) into the uterus, and cauterizing the clitoris. Suddenly, letting a health professional get to third base doesn’t sound so bad.

Also, there’s no evidence that prurience drove MDs’ advocacy of manual massage – on the contrary, they eagerly farmed out the task to subordinates. Or turned to technology. Water jets were used this way 150 years ago; following the development of windup and steam-powered massage devices intended for sore muscles, arthritis, and so on, Joseph Mortimer Granville invented the modern electromechanical vibrator in the early 1880s. Granville himself opposed its use on women, but that didn’t stop physicians. Vibrators were among the first electric appliances marketed for home use, with the sexual angle carefully downplayed – the units were about as phallic as an electric egg beater. Presumably many customers used them for the muscle massage touted in the ads, but surely not all. Greater public acknowledgment of women’s sexuality made it too clear what female users might be up to, and as of the 1930s mainstream publications had stopped advertising them.

By then the medical treatment was faltering. Though poorly explained nervous disorders (see neurasthenia) had been the rage among upper-class Victorians, styles changed in the new century. It was Freud’s influence in particular that ended medical masturbation. He administered it early on but found it ineffective – as Maines puts it, “the man who, notoriously, did not know what women wanted was less than successful as a gynecological masseur.” Freud later concluded only talk therapy could resolve underlying issues; there, too, his efforts weren’t entirely satisfying.

Hysteria has since been all but defined out of existence. Those who once would have been labeled hysterical might now be described as having conversion disorder, or just a healthy libido. Meanwhile, in a culture that’s more sex-positive but body-fat-negative, eating disorders have in some senses taken hysteria’s place – hardly a real improvement.